| NPI | 1043253925 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLOTTE KAY INGWERSEN President 502-955-5200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: KY 32033) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2013-11-20 |